Neoadjuvant Therapy for
Breast Cancer: a New Perspective for Breast Cancer Treatment I. Introduction Breast cancer, as a major threat to women’s health around the world, has a high incidence. In the field of breast cancer treatment, with the deepening of medical research, treatment methods are increasingly rich and diverse. Among them, neoadjuvant therapy, as an important treatment strategy, is gradually receiving widespread attention. It brings new hope and more treatment options for breast cancer patients, especially those with more complex conditions. This article will give a comprehensive introduction to the neoadjuvant therapy of breast cancer to help you better understand this important treatment. 2. What is neoadjuvant therapy for breast cancer? Simply speaking, neoadjuvant therapy for breast cancer is a series of systemic treatment measures for patients before surgical resection of tumors. Its purpose is to reduce the tumor volume, reduce the tumor stage, so that patients who can not be operated or are difficult to operate can get better surgical conditions, and at the same time, it can understand the sensitivity of tumors to therapeutic drugs in advance, and provide a basis for the adjustment of follow-up treatment. Neoadjuvant therapy mainly includes neoadjuvant chemotherapy, neoadjuvant endocrine therapy and neoadjuvant targeted therapy. These treatments can be used alone or in combination according to the specific condition of the patient. 3. Principle of neoadjuvant chemotherapy (1) Neoadjuvant chemotherapy is to use chemical drugs to reach all parts of the body through blood circulation to kill tumor cells. These chemotherapeutic drugs can interfere with the growth, division and reproduction of tumor cells, prevent their further proliferation, and thus achieve the purpose of reducing tumors. (2) It is generally applicable to large tumors (usually more than 2 cm in diameter), possible metastasis of axillary lymph nodes, and locally advanced breast cancer. For example, for some patients with stage III breast cancer, neoadjuvant chemotherapy can effectively shrink the tumor, making it possible to change from an inoperable state to an operable state. (3) Commonly used neoadjuvant chemotherapy drugs include anthracyclines (such as doxorubicin, epirubicin, etc.), taxanes (such as paclitaxel, docetaxel, etc.) And cyclophosphamide. Different drug combinations will be determined according to the patient’s specific condition, physical condition and the biological characteristics of the tumor. (4) Treatment cycles usually require multiple cycles of neoadjuvant chemotherapy, usually ranging from 4 to 8 cycles. There will be a certain interval between each cycle, so that the patient’s body has time to recover and reduce the adverse reactions caused by chemotherapy drugs. (5) Adverse reactions Neoadjuvant chemotherapy can bring some adverse reactions to patients, including nausea, vomiting, alopecia, bone marrow suppression (resulting in decreased white blood cells, red blood cells, platelets, etc.), fatigue and so on. However, with the development of modern medicine, there are many effective measures to deal with these adverse reactions, such as the use of antiemetic drugs, leukocyte-raising drugs, which can alleviate the pain of patients to a certain extent. 4. Principle of neoadjuvant endocrine therapy (1) The growth and proliferation of breast cancer cells are often closely related to hormone levels in the body, especially estrogen and progesterone. Neoadjuvant endocrine therapy is to inhibit the dependence of tumor cells on hormones by regulating hormone levels in vivo, so as to achieve the purpose of inhibiting tumor growth. (2) It is mainly applicable to breast cancer patients with positive estrogen receptor (ER) and progesterone receptor (PR). Tumor cells in these patients are more sensitive to hormones, and endocrine therapy can effectively control the growth of tumors. For example, neoadjuvant endocrine therapy is a good choice for some older, relatively poor physical condition patients with ER and PR positive breast cancer who can not tolerate chemotherapy. (3) Commonly used neoadjuvant endocrine therapy drugs include tamoxifen, letrozole and anastrozole. These drugs regulate hormone levels through different mechanisms, such as tamoxifen, which binds to estrogen receptors and blocks the stimulation of estrogen to tumor cells, while letrozole and anastrozole play a role by inhibiting the synthesis of estrogen. (4) The treatment cycle of neoadjuvant endocrine therapy is relatively long, which generally lasts for 6-12 months. Because the effect of endocrine therapy is relatively slow, it takes some time to give full play to its effect of inhibiting tumor growth. (5) Adverse reactions are relatively mild, such as hot flashes, vaginal dryness, osteoporosis and so on. These adverse reactions can also be alleviated by some adjuvant treatment measures, such as calcium supplementation and vitamin D to prevent osteoporosis. 5. Principle of new auxiliary targeted therapy (1) New auxiliary targeted therapy is a precise attack on specific molecular targets on the surface of tumor cells. Tumor cells express some specific molecules different from normal cells in the process of growth. Targeted therapy drugs can specifically bind to these targets and block the growth, proliferation and metastasis signaling pathways of tumor cells, so as to achieve the purpose of inhibiting tumor growth. (2) Applicable conditions are mainly applicable to breast cancer patients with positive human epidermal growth factor receptor 2 (HER2). HER2 protein is overexpressed on the surface of HER2-positive breast cancer cells, and targeted therapeutic drugs can effectively attack this target. For example, for some HER2-positive and more severe breast cancer patients, neoadjuvant targeted therapy can significantly reduce the tumor volume and improve the resection rate. (3) Commonly used drugs Common new adjuvant targeted therapy drugs include trastuzumab and pertuzumab. These drugs play an important role in the treatment of HER2-positive breast cancer and are often combined with chemotherapy drugs to enhance the therapeutic effect. (4) Treatment cycle The cycle of neoadjuvant targeted therapy will also depend on the specific condition, generally ranging from 4 to 8 cycles, similar to the chemotherapy cycle. (5) Adverse reactions are lighter than chemotherapy, but there are also some conditions, such as cardiotoxicity (trastuzumab may cause), diarrhea, rash and so on. In the course of treatment, we need to pay close attention to the physical condition of patients, and timely detect and deal with these adverse reactions. 6. Advantages of neoadjuvant therapy (1) Reducing tumor volume and improving surgical resection rate Through neoadjuvant therapy, the tumor volume can be significantly reduced, the tumor that is difficult to resect can be resected, or the tumor that needs to be resected in a large range can be resected in a smaller range, so as to improve the surgical resection rate and reduce the difficulty of surgery. (2) To understand the sensitivity of tumors to therapeutic drugs in advance, neoadjuvant therapy before surgery can observe the response of tumors to different drugs, so as to know which drugs are most effective for patients’tumors in advance, and provide a basis for subsequent treatment plan adjustment. If the tumor is found to be insensitive to a certain drug during neoadjuvant therapy, other more effective drugs can be replaced in subsequent treatment. (3) Increased chances of breast conservation For some breast cancer patients who want to preserve their breasts, neoadjuvant therapy can reduce the tumor volume, so that patients who do not meet the conditions of breast-conserving surgery may be eligible, thus increasing the chances of breast conservation, which has an important impact on the psychological and quality of life of patients. 7. Evaluation and monitoring of neoadjuvant therapy (1) Evaluation indicators In the course of neoadjuvant therapy, patients need to be evaluated regularly. The main evaluation indicators include changes in tumor size, axillary lymph node status, and tumor marker levels. Through these indicators, we can intuitively understand the effect of neoadjuvant therapy. (2) Monitoring methods Commonly used monitoring methods include breast ultrasound, mammography, breast magnetic resonance imaging (MRI) and other imaging examinations, as well as blood tests (detection of tumor markers, etc.). These examinations can accurately monitor the effect of neoadjuvant therapy at different stages, so as to adjust the treatment plan in time. (3) Adjustment of treatment plan If the tumor does not shrink as expected or new metastases occur in the course of neoadjuvant therapy, it is necessary to adjust the treatment plan in time. Drugs may be changed, doses of drugs may be increased, and treatment modalities may be changed (such as from monotherapy to combination therapy) to ensure the effectiveness of treatment. 8. Risks and challenges of neoadjuvant therapy (1) Adverse reactions in the course of treatment As mentioned above, various ways of neoadjuvant therapy will bring some adverse reactions. Although these adverse reactions can be alleviated by some measures, they will still bring some pain to patients and affect their quality of life. (2) Uncertainty of therapeutic effect Although neoadjuvant therapy can achieve good results in many cases, not all patients can achieve the desired therapeutic goal. Some patients may not be able to shrink after neoadjuvant therapy, or recur soon after shrinking, which requires further research and exploration on how to improve the effect of neoadjuvant therapy. (3) Delayed operation time Neo-adjuvant therapy needs a certain amount of time to complete, which means that the operation time will be delayed accordingly. For some patients with rapid disease development, delaying the operation time may bring certain risks, such as further deterioration of tumors or new metastases. 9. Surgery and follow-up treatment after neoadjuvant therapy (1) After neoadjuvant therapy, the appropriate surgical method should be selected according to the size, location and axillary lymph node status of the tumor. Breast-conserving surgery may be an option if the tumor has shrunk enough to be breast-conserving and the patient has a desire to conserve breast; traditional radical mastectomy or modified radical mastectomy may be required if the tumor is still large or if other conditions are not suitable for breast-conserving surgery. (2) Follow-up treatment No matter which surgical method is chosen, patients after neoadjuvant therapy need follow-up treatment. The follow-up treatment plan will also be determined according to the patient’s pathological results, tumor marker levels and other factors. Generally speaking, follow-up treatment may include radiotherapy, endocrine therapy, targeted therapy, etc. To further consolidate the therapeutic effect and prevent tumor recurrence. 10. Patient education and psychological support (1) Patient education Before neoadjuvant therapy, healthcare workers should fully educate patients to understand the principle, applicability, treatment cycle and adverse reactions of neoadjuvant therapy. Only on the basis of full understanding, can patients better cooperate with the treatment, and can timely detect and report abnormal conditions in the course of treatment. (2) Psychological support Breast cancer patients often have anxiety, fear and other psychological emotions in the face of neoadjuvant therapy. Healthcare workers, family members and society should give patients adequate psychological support, so that patients feel care and encouragement, and help patients build confidence in overcoming the disease. 11. Conclusion Neoadjuvant therapy for breast cancer, as an important therapeutic strategy, plays an increasingly important role in the treatment of breast cancer. It provides more treatment options and better therapeutic effects for breast cancer patients by reducing the size of tumors and knowing the sensitivity of tumors to therapeutic drugs in advance. However, we should also see the risks and challenges of neoadjuvant therapy, and we need to constantly study and explore how to improve its therapeutic effect, while giving patients adequate education and psychological support, so that patients can better cope with the disease and strive for an early recovery. With the continuous development of medical technology, it is believed that the neoadjuvant therapy for breast cancer will continue to improve and bring good news to more breast cancer patients.
